Provider Demographics
NPI:1255328654
Name:LANDRY, MARK E (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:LANDRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2375
Mailing Address - Country:US
Mailing Address - Phone:913-438-9898
Mailing Address - Fax:913-438-9899
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:SUITE 260
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2375
Practice Address - Country:US
Practice Address - Phone:913-438-9898
Practice Address - Fax:913-438-9899
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2017-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS12-00167213ES0103X
MO000415213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
06651156OtherBC
015070OtherBC KS
480018248OtherRR MCR
T883702Medicare PIN
KST77039Medicare UPIN
480018248OtherRR MCR
D663702DMedicare PIN